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As Published in MEDICAL CHRONICLE
PACS & RIS Solutions: Theory vs Reality
by Lisa Anderson-Morshead
Picture archiving and communications systems (PACS) in conjunction with radiology information systems (RIS) have been one of the success stories in the field of medical information technology (IT). Feature-rich and fully integrated RIS/PACS solutions have been engineered to expand the capabilities of the radiology environment to keep up with the increasing demand for a comprehensive, cost-effective digital image
and practice management solutions.
The modernised use of IT in radiology in SA, including the efficient use of RIS and PACS is fast becoming a controversial discussion point amongst radiologists, radiographers, referring doctors and service providers alike. Although PACS and RIS vendors claim to streamline and drastically improve the efficiency and speed of practice workflow, it is clear that there is a great divide between what is offered in theory vs what is deliverable in practise.
Revolutionary changes in radiology, due to the high-end digital imaging data now available, have forced advances in medical IT at such a rapid pace that vendors can seldom keep up. Despite this, Pro Med Computer Services have successfully installed a seamless integrated RIS/PACS and Billing Solution in multiple sites countrywide (See www.charismasolutions.com).The Q&A below puts a few of the imperative points into perspective when it comes to the ideal solution.
What makes the RIS system so important to receptionists?
Standard RIS systems are designed to retrieve patient data from the HIS, which is used in most cases as a scheduling system, rather than a data capture system. In reality, most data capturing in South African practices are performed by receptionists. This includes the capturing of all data pertaining to the patient, from clinical through to medical scheme claims and billing information. A system that does not allow full data capturing or correct scanning facilities, puts enormous strain on this resource.
Pro Med designed a system suited to receptionists to allow:
• Speed and accuracy as the data can be immediately digitised into the RIS.
• The creation of a unique ID for the patient, across all branches, which identifies the patient over and above the South African state ID ,which can only be relied on for approximately 70% of the cases.
• A more refined document scanning solution, allowing batch scanning for multiple documents per patient, which can be immediately captured and linked to that unique patient ID.
• The receptionist to be multifunctional, especially in smaller practices where he/she can perform functions such as, scheduling, patient data capture, billing and receipting from the same platform.
How does an efficient RIS PACS system benefit radiographers?
Generically, PACS should save the radiographer time and thus, save the practice money. However, these systems are only as efficient as their ability to perform the necessary tasks the radiographer has to execute.
Any RIS/PACS system should benefit the radiographer with regards to receiving patient data immediately, anywhere within the department. The DICOM worklist is also now successfully implemented as a standard which is very user friendly. Not all systems are designed to successfully enhance the radiographers’ performance on multiple levels.
The company’s keen understanding of the field is key to enhancing the radiographers’ performance, which is clearly shown by its unique system which allows:
• Access to the exact billing/tariff codes corresponding to the type of procedure.
• The receptionist to simply select the exam level description, leaving the radiographeror radiologist to select the exact type of procedure, which is directly linked to the billing code.
• The radiographer or radiologist to access the billing codes for consumables.
Do radiologists really have access toall the data anywhere and anytime?
It is uncertain if radiologists are benefitting from this promise to receive all the RIS/PACS data anywhere and anytime. It is common knowledge in the field of RIS/PACS that any system should provide an all-integrated seamless solution to the radiologist with basic functionality involving:
• A centralised worklist for the practice.
• Soft copy reading.
• High end 3D reconstruction.
• Access to scanned documents.
• Voice recognition reporting.
This however, does not assure that the radiologist has access to all the data. Making all the images available in the correct format, at the right time and place, is not as simple as it sounds. In order to really work, the process relies on DICOM and HL7 technology from a variety of vendors. Pro Med’s large installation base and experience with multi-modalities and vendors affords the company the real skills to make the solution
fully functional for radiologists. Having access to the complete system from home is a fundamental part of practice efficiency.
Expectations from hospitals and doctors have increased with new technology. Not all systems can offer this optimal solution. Pro Med has utilised the electronic power of RIS and PACS to make improvements in the delivery of data to the radiologist. Its solution allows:
• Access to all billing codes fully integrated into the billing system.
• Full workflow orientated communication with the radiographer.
• Fully integrated ICD10 coding system.
• Auto distribution of reports to the referring doctors via their preferred process; i.e. fax, email, print.
• Full home reporting through a fully web based system.
Is the referring doctor really benefitting from the RIS/PACS system?
The success and cost savings of a true RIS/PACS system can be measured by the benefits felt by the patient and referring doctor. Many healthcare professionals are not yet comfortable with technology. Therefore, the PACS system should make procedures in health care simpler and faster. Patients need to know that their health professionals care. The referring doctors needs to be able to easily embrace this technological advancement and realise the benefits of receiving the reports and images digitally.
This process relies heavily on:
• User-friendly applications.
• Access to the correct tools for the referring doctors speciality.
• The application being able to run on a variety of hardware and being compatible with different systems- there is no uniformity in this area regarding hospital or doctors practices.
• Correct training, which allows the user to be comfortable and confident with the system.
In an effort to strengthen ties with the referring doctors, Pro Med is involved in the processes leading up to the switch over to its system. The referring doctor is trained with emphasis on the benefits and functions.
Many doctors are still afraid to move into the electronic age and need to be coerced with proficient training. Doctors can view reports with associated images selected by the radiologist. They will also have access to the complete imaging history of the patient, including prior reports and images. Referring doctors can access and view images at the same time that the radiologist is interpreting the exam. Insufficient training would result in frustration if the doctors are unable to use these tools successfully.
Do multisite installations work on a centralised system in certain practices?
Certain systems can only work from a single central RIS/PACS server, putting pressure on the WAN infrastructure to enable the remote branches to function. Other solutions have pure stand alone databases at each branch without a central database. Pro Med has optimised its system to incorporate the best of both solutions, while still maintaining central unique patient ID across the practice. Remote branches will function in case of WAN failure alongside a centralised worklist enabling multisite reporting.
Reporting can take place from any site, using web technology.
How does billing integrate into the RIS and is money being saved?
It is safe to say that a practice is at a risk of losing revenue if the doctor does not have a successful integration of his/her billing system into his/her RIS. Most systems come with a separate billing package. A separate application has to be opened for billing, feeing and receipting as the function cannot be performed from the RIS. Without an integrated billing system, practices may experience delays in claims, as well as the loss of billing data. Pro Med’s recent inclusion of the all new IBM SYSTEM i5 servers (one of the most powerful and cost-effective servers available), ensures that its customers are able to transfer their existing Pro Med billing structure from the AS400 platform to this latest technology. The billing system is excellent in its stability
and proficiency to keep the debtors’ book stable and the cash flowing into the practice.
This is why the integrated billing system initiated at reception allows:
• Patient validation,
• Online claims,
• Automatic receipting from medical schemes,
• Feeing,
• Billing,
• Receipting,
• Statement printing,
• Receipt printing,
• Access to feeing by the radiographer and radiologist,
• The recently-added ICD10 coder application to simplify the process for the radiologist, ICD109 coder or
feeing clerk alike,
• Debtors module enabling improved cash flow and more accurate billing,
• Integration, which ensures data integrity,
• Correct controls and balance procedures to protect against loss of data.
Ultimately, the solution will only be as capable as its weakest link. It is imperative that all the components of an efficient RIS/PACS/Billing system function properly, and more importantly, as a single unit. As a practice owner, the first port of call would be to partner with an experienced vendor with a proven track record. This will guarantee a successful installation followed by all the benefits promised. Pro Med has an uncontested track record to date, which is aiding many practices countrywide to maximise the returns from their initial investment. |
